<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>《药品经营许可证》注销</title>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, user-scalable=no">
    <link rel="stylesheet" href="#(basePath)/static/jquery-weui/css/weui.min.css">
    <link rel="stylesheet" href="#(basePath)/static/jquery-weui/css/jquery-weui.min.css">
    <link rel="stylesheet" href="#(basePath)/static/web/index/css/index.css">
</head>
<body>
<div class="page">
    <div class="page__hd">
        <div class="page__title">
            <header class="weui-header">
                <h1 class="weui-header-title">《医疗器械经营许可证》<br/>注销</h1>
            </header>
        </div>
    </div>
    <div class="page__bd page__bd_spacing">
        <form action="#(basePath)/wfw/spyxmp/ylqxjyxkz/save" method="post" data-role="form">
            <input type="hidden" name="type" value="2">
            <div class="weui-cells weui-cells_radio weui-cells_radio_native">
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">许可证编号</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="xkzbh" value="#(data.xkzbh??)"
                               placeholder="请输入许可证编号" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">企业名称</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="qymc" value="#(data.qymc??)"
                               placeholder="请输入企业名称" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">申请日期</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="date" name="sqrq" value="#date(data.sqrq??)"
                               placeholder="请选择申请日期（许可证）" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">发证日期</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="date" name="fzrq" value="#date(data.fzrq??)"
                               placeholder="请选择发证日期（许可证）" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">组织机构代码</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="tyshxydm" value="#(data.tyshxydm??)"
                               placeholder="请输入组织机构代码" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">有效期限</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="yxqx" value="#(data.yxqx??)"
                               placeholder="请选择有效期限（许可证）" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">法定代表人</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="fddbr" value="#(data.fddbr??)"
                               placeholder="请输入法定代表人" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">企业负责人</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="qyfzr" value="#(data.qyfzr??)"
                               placeholder="请输入企业负责人" required>
                    </div>
                </div>
                <div class="weui-cell weui-cell__title">
                    经营方式？
                    <label style="font-size: 10px;color: red;">注销仅支持零售方式</label>
                </div>
                <label class="weui-cell weui-check__label" for="jyfs1">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="1" id="jyfs1" required disabled>
                        <span>批发</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyfs2">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="2" id="jyfs2" required checked="checked">
                        <span>零售</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyfs3">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="3" id="jyfs3" required disabled>
                        <span>批零兼售</span>
                    </div>
                </label>
                <div class="weui-cell weui-cell__title">
                    经营模式？
                </div>
                <label class="weui-cell weui-check__label" for="jyms1">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyms" value="1" id="jyms1" required #(data.jyms??=="1"?"checked":"")>
                        <span>销售医疗器械</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyms2">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyms" value="2" id="jyms2" required #(data.jyms??=="2"?"checked":"")>
                        <span>为其他生产经营企业提供贮存、配送服务</span>
                    </div>
                </label>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">住所</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="zs" value="#(data.zs??)"
                               placeholder="请输入住所地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">经营场所</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="jycs" value="#(data.jycs??)"
                               placeholder="请输入经营场所地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">库房地址</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="kfdz" value="#(data.kfdz??)"
                               placeholder="请输入库房地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">经营范围</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="jyfw" value="#(data.jyfw??)"
                               placeholder="请输入经营范围" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">联系人名称</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrxm" value="#(data.lxrxm??==null?session.wxUserInfo.name:data.lxrxm??)"
                               placeholder="请输入联系人名称" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">身份证号</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrzjhm" value="#(data.lxrzjhm??)"
                               placeholder="请输入联系人身份证号" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">电话</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrdh" value="#(data.lxrdh??==null?session.wxUserInfo.phone:data.lxrdh??)"
                               placeholder="请输入联系人电话" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">传真</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrcz" value="#(data.lxrcz??)"
                               placeholder="请输入联系人传真" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">电子邮件</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="email" name="lxryx" value="#(data.lxryx??)"
                               placeholder="请输入联系人电子邮件" required>
                    </div>
                </div>
                <div class="weui-cell weui-cell__title">
                    注销原因
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__bd weui-cell__primary">
                    <textarea class="weui-textarea"
                              placeholder="请输入注销原因" rows="3"
                              name="reason">#(data.reason??)</textarea>
                    </div>
                </div>
            </div>
            <div class="weui-cells weui-cells_radio weui-cells_radio_native">
                <div class="weui-cell weui-cell__title">
                    是否具备原件？
                </div>
                <label class="weui-cell weui-check__label" for="sfjbyj1">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="sfjbyj" value="1" id="sfjbyj1" required #(data.sfjbyj??=="1"?"checked":"")>
                        <span>是</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="sfjbyj0">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="sfjbyj" value="0" id="sfjbyj0" required #(data.sfjbyj??=="0"?"checked":"")>
                        <span>否</span>
                    </div>
                </label>
            </div>
            #set(clxs=data.sfjbyj??=="0"?"block":"none")
            <div id="material" style="display: #(clxs);">
                <div data-role="upload"
                     data-content='{"label": "遗失声明（<label style=color:red>或情况说明，需盖章</label>）", "params": {"tableName": "SPYXMP_YLQXJYXKZ", "sblsh":"#(data.APPLYID??)"}}'>
                </div>
            </div>
            #set(yzxs=data.sfjbyj??=="1"?"block":"none")
            <div id="yzxx" style="display: #(yzxs);">
                <div class="weui-cells__title">邮寄信息</div>
                <div class="weui-cells">
                    <div class="weui-cell">
                        <div class="weui-cell__hd"><label class="weui-label">邮寄人名称</label></div>
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" name="yjr" value="#(data.yjr??)"
                                   placeholder="请输入邮寄人名称" required>
                        </div>
                    </div>
                    <div class="weui-cell">
                        <div class="weui-cell__hd"><label class="weui-label">邮寄人电话</label></div>
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="mailPhone" name="yjrdh" value="#(data.yjrdh??)"
                                   placeholder="请输入邮寄人电话" required>
                        </div>
                    </div>
                    <div class="weui-cell weui-cell__title">
                        邮寄地址
                        <label style="font-size: 10px;color: red;">&nbsp;仅限东莞地区，格式：广东省东莞市xxxx</label>
                    </div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                                <textarea class="weui-textarea" placeholder="请输入邮寄地址" rows="3" required
                                          name="yjrdz">#(data.yjrdz??)
                                </textarea>
                        </div>
                    </div>
                </div>
            </div>
            <div class="weui-btn-area">
                #if(model??=="readonly")
                <a href="#(basePath)/wfw/spyxmp/applyItem/toSbls" class="weui-btn weui-btn_primary">返回申报历史</a>
                #else
                <button class="weui-btn weui-btn_primary" type="submit">提交申请</button>
                #end
            </div>
            <br><br>
        </form>

    </div>
    <div class="page__footer">

        #include("/WEB-INF/main/footer-spyxmp.html")
    </div>
</div>
<script src="#(basePath)/static/js/weuiUpload.js"></script>
<script src="#(basePath)/static/web/spyxmp/js/xkzbh.js"></script>
<script src="#(basePath)/static/web/spyxmp/js/zxxx.js"></script>
<script type="text/javascript">
    $("#jyfs").select({
        title: "选择经营方式",
        items: [
            {
                title: "批发",
                value: "1",
            },
            {
                title: "零售",
                value: "2",
            },
            {
                title: "批零兼",
                value: "3",
            }
        ]
    });
    $("#jyms").select({
        title: "选择经营模式",
        items: [
            {
                title: "销售医疗器械",
                value: "1",
            },
            {
                title: "为其他生产经营企业提供贮存、配送服务",
                value: "2",
            }
        ]
    });
</script>
</body>
</html>